Bladder Cancer Staging 

Updated: Dec 30, 2015
  • Author: Gary David Steinberg, MD, FACS; Chief Editor: Jules E Harris, MD, FACP, FRCPC  more...
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TNM Classification for Bladder Cancer

The TNM classification for staging of bladder cancer is provided below. [1]

Table. TNM Classification for Bladder Cancer (Open Table in a new window)

Primary tumor (T)
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
Ta Noninvasive papillary carcinoma
Tis Carcinoma in situ: “flat tumor”
T1 Tumor invades subepithelial connective tissue
T2 Tumor invades muscularis propria
pT2a Tumor invades superficial muscularis propria (inner half)
pT2b Tumor invades deep muscularis propria (outer half)
T3 Tumor invades perivesical tissue
pT3a Microscopically
pT3b Macroscopically (extravesical mass)
T4 Tumor invades any of the following: prostatic stroma, seminal vesicles, uterus, vagina, pelvic wall, abdominal wall
T4a Tumor invades prostatic stroma, uterus, vagina
T4b Tumor invades pelvic wall, abdominal wall
Regional lymph nodes (N)
Regional lymph nodes include both primary and secondary drainage regions. All other nodes above the aortic bifurcation are considered distant lymph nodes.
NX Lymph nodes cannot be assessed
N0 No lymph node metastasis
N1 Single regional lymph node metastasis in the true pelvis (hypogastric, obturator, external iliac, or presacral lymph node)
N2 Multiple regional lymph node metastasis in the true pelvis (hypogastric, obturator, external iliac, or presacral lymph node metastasis)
N3 Lymph node metastasis to the common iliac lymph nodes
Distant metastasis (M)
MO No distant metastasis
M1 Distant metastasis

Table. Anatomic stage/prognostic groups (Open Table in a new window)

Stage T N M
Stage 0a Ta N0 M0
Stage 0is Tis N0 M0
Stage I T1 N0 M0
Stage II T2a N0 M0
  T2b N0 M0
Stage III T3a N0 M0
  T3b N0 M0
  T4a N0 M0
Stage IV T4b N0 M0
  Any T N1-3 M0
  Any T Any N M1